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Medicare enrollment in Nebraska

As of November 2018, 338,794 Nebraska residents had Medicare coverage. That’s a little more than 17 percent of the state’s population, and slightly lower than the more than 18 percent of the United States population that is enrolled in Medicare.

Most Medicare beneficiaries are eligible for coverage because they’re at least 65 years old. But Medicare eligibility is also triggered when a person has been receiving disability benefits for 24 months. Nationwide, 16 percent of all Medicare beneficiaries are eligible due to disability. It’s a little lower in Nebraska, with just 13 percent of Medicare beneficiaries enrolled due to a disability.

Medicare Advantage in Nebraska

Although Medicare is funded and run by the federal government, enrollees can choose whether they want to receive their benefits directly from the federal government via Original Medicare or enroll in a Medicare Advantage plan offered by a private insurer, if such plans are available in their area.

Although most counties in the United States do have Medicare Advantage plans available for purchase, there are quite a few areas in Nebraska where Original Medicare is the only option. Nebraska has 93 counties, and Medicare Advantage plans are available in 67 of them in 2019. Across those 67 counties, plan availability ranges from just one plan in Box Butte, Hamilton, and Kearney counties to 15 plans in Douglas and Sarpy counties.

Original Medicare includes Medicare Parts A and B. Medicare Advantage plans include all of the benefits of Medicare Parts A and B, and Advantage plans typically have additional benefits, such as integrated Part D prescription drug coverage and extras like dental and vision. But Advantage plans have limited provider networks (compared with the nationwide network of providers who participate with Original Medicare), and out-of-pocket costs are often higher than they would be under Original Medicare plus a Medigap plan. There are pros and cons to Medicare Advantage and Original Medicare, and no single solution that works for everyone.

Only 14 percent of Medicare beneficiaries in Nebraska were enrolled in Medicare Advantage plans as of 2017, compared with an average of 33 percent nationwide. The lower enrollment in Nebraska is due in part to the fact more than a quarter of the counties in Nebraska don’t have Medicare Advantage plans available for purchase. As of November 2018, just 50,316 Medicare beneficiaries in Nebraska were enrolled in private Medicare plans (as opposed to Original Medicare; that figure does not include people who had private coverage to supplement Original Medicare). That’s less than 15 percent of the state’s Medicare population, and although most of those enrollees have Medicare Advantage, there are some enrollees in Nebraska who have Medicare Cost plans, which is another form of private Medicare coverage.

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the opportunity to switch between Medicare Advantage and Original Medicare and/or add or drop a Medicare Part D prescription plan. As of 2019, Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

Medigap in Nebraska

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. More than half of Original Medicare beneficiaries receive their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) are designed to pay some or all of the out-of-pocket costs (deductibles and coinsurance) that Medicare beneficiaries would otherwise have to pay themselves.

Medigap plans are sold by private insurers, but the plans are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N). The benefits offered by a particular plan (Plan C, Plan F, etc.) are the same regardless of which insurer is selling the plan. So plan comparisons are much easier for Medigap policies than for other types of health insurance; consumers can base their decision on premiums and less tangible things like customer service, since the benefits themselves are uniform.

There are 48 insurers in Nebraska that offer Medigap plans, and according to an AHIP analysis, there were 168,945 Nebraska Medigap enrollees in 2016. So almost 60 percent of Nebraska’s Original Medicare population (and about half of the state’s entire Medicare population) has supplemental coverage through Medigap plans. This is higher than the rate in most states; nationwide, about a quarter of Original Medicare beneficiaries have Medigap coverage.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you must be enrolled in both Part A and Part B to buy a Medigap plan).

People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, and 13 percent of Nebraska Medicare beneficiaries are under 65 years old. But federal rules do not guarantee access to Medigap plans for people who are under 65. The majority of the states have stepped in to ensure at least some access to private Medigap plans for disabled enrollees under the age of 65, but Nebraska has not. Medigap insurers in Nebraska are not required to offer coverage to people under 65 years of age. That doesn’t mean none of them will; United American Insurance, for example, confirmed that they do offer Medigap plans in Nebraska to disabled beneficiaries.

Instead of requiring private insurers to offer coverage, Nebraska’s safety-net option is to allow Medicare enrollees under the age of 65 to enroll in the state’s high-risk pool (NECHIP). But the pool does not sell regular Medigap plans (the way South Carolina’s high-risk pool does). Instead, NECHIP continues to offer the type of coverage that they provided prior to 2014, for people who couldn’t get coverage in the individual insurance market due to medical underwriting. The plans have deductibles that range from $5,000 to $10,000, and premiums vary based on age, tobacco use, and the deductible that the person selects. By state law, premiums are set higher than private individual market rates. But unlike regular individual market plans, the NECHIP coverage does work in conjunction with Medicare, helping to cover out-of-pocket costs that enrollees would otherwise have (Alaska, Iowa, Nebraska, New Mexico, North Dakota, South Carolina, Washington, and Wyoming also have high-risk pools that remain operational and offer supplemental coverage to Medicare beneficiaries).

As of 2019, however, there are only two people enrolled in NECHIP coverage in Nebraska. It appears that the vast majority of the state’s disabled Medicare beneficiaries either have supplemental Medicaid or employer-sponsored coverage, have obtained Medigap coverage via a private insurer that does sell plans to people under 65, or have enrolled in Medicare Advantage plans instead of Original Medicare (Medicare Advantage is available to Medicare beneficiaries of any age, although people with kidney failure generally cannot join a Medicare Advantage plan). There are also likely some who are just relying on Original Medicare without any supplemental coverage. Disabled Medicare beneficiaries have access to the normal federally-required Medigap open enrollment period when they turn 65, regardless of how long they’ve been enrolled in Original Medicare at that point.

Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those regulations don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months, if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the insurer can look back at your medical history in determining whether to accept your application, and at what premium.

Medicare Part D in Nebraska

Original Medicare does not cover outpatient prescription drugs. More than half of Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan or Medicaid, and these plans often include prescription coverage. But Medicare enrollees without creditable drug coverage need to obtain Medicare Part D prescription coverage. Part D coverage can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan that includes Part D prescription drug coverage.

As of late 2018, there were 202,647 Medicare beneficiaries in Nebraska with prescription coverage under stand-alone Part D plans. Another 43,502 had Part D prescription coverage as part of their Medicare Advantage plans.

Medicare spending in Nebraska

In 2016, Original Medicare’s average per-beneficiary spending in Nebraska was $9,025, based on data standardized to eliminate regional differences in payment rates (the data did not include costs for Medicare Advantage).

Nationwide, average per beneficiary Original Medicare spending was $9,533 per enrollee, so Medicare spending in Nebraska was about 5 percent below the national average. Per-beneficiary Original Medicare spending was highest in Louisiana, at $11,399, and lowest in Hawaii, at just $6,441.